Do you need child care?

If yes, please complete the information below & submit.

Child's Information *
Child's Information
Child's Name
Child's Date of birth *
Child's Date of birth
Gender *
Child's Home Address *
Child's Home Address
Child's Home Phone Number *
Child's Home Phone Number
Does your child have any allergies? *
*If your child is anaphylactic you must complete the Anaphylaxis Emergency Plan Form prior to your child’s start date.
Does your child have an Epipen? *
Does your child have any special medication information? *
*If your child needs to receive drug or medication at The Learning Centre you must complete the Authorization for Drug/Medication Administration Form prior to your child’s start date.
Has your child been diagnosed with a medical condition? *
*If your child has a medical condition you must complete the Individualized Plan for a Child with Medical Needs prior to your child’s start date.
Any special requirements in respect of diet, rest or physical activity. Any previous history of communicable diseases, conditions requiring medical attention. Any food sensitivity, etc.
Parent Information *
Parent Information
Parent Phone Number *
Parent Phone Number
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